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Predictive factors for failure of nonoperative management in perforated appendicitis

Abstract

BACKGROUND: Identifying patients on admission with perforated appendicitis who have phlegmon or abscess initially selected for but likely to fail nonoperative management may avoid delays in definitive treatment.

METHODS: Patients older than 15 years presenting to a university tertiary care hospital with perforated appendicitis and abscess or phlegmon and planned nonoperative management were reviewed. Comorbidities, clinical findings, laboratory markers, radiographic findings, and nonsurgical treatments associated with failure of nonoperative management were recorded.

CONCLUSION: Patients with perforated appendicitis and phlegmon or abscess who smoke or present with tachycardia, generalized abdominal tenderness, and abscesses smaller than 50 mm are more likely to fail nonoperative management and should be considered for early operation. These findings should be validated prospectively.

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